Healthcare Provider Details

I. General information

NPI: 1205868601
Provider Name (Legal Business Name): MARTHA W NYE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 RIVER BEND DR
DALLAS TX
75247-4914
US

IV. Provider business mailing address

1380 RIVER BEND DR
DALLAS TX
75247-4914
US

V. Phone/Fax

Practice location:
  • Phone: 214-743-1270
  • Fax: 214-905-9245
Mailing address:
  • Phone: 214-743-1270
  • Fax: 214-905-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number08451
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: